Abstract
BackgroundNoninvasive ventilation is used worldwide in many settings. Its effectiveness has been proven for common clinical conditions in critical care such as cardiogenic pulmonary edema and chronic obstructive pulmonary disease exacerbations.Since the first pioneering studies of noninvasive ventilation in critical care in the late 1980s, thousands of studies and articles have been published on this topic. Interestingly, some aspects remain controversial (e.g. its use in de-novo hypoxemic respiratory failure, role of sedation, self-induced lung injury). Moreover, the role of NIV has recently been questioned and reconsidered in light of the recent reports of new techniques such as high-flow oxygen nasal therapy.MethodsWe conducted a survey among leading experts on NIV aiming to 1) identify a selection of 10 important articles on NIV in the critical care setting 2) summarize the reasons for the selection of each study 3) offer insights on the future for both clinical application and research on NIV.ResultsThe experts selected articles over a span of 26 years, more clustered in the last 15 years. The most voted article studied the role of NIV in acute exacerbation chronic pulmonary disease. Concerning the future of clinical applications for and research on NIV, most of the experts forecast the development of innovative new interfaces more adaptable to patients characteristics, the need for good well-designed large randomized controlled trials of NIV in acute “de novo” hypoxemic respiratory failure (including its comparison with high-flow oxygen nasal therapy) and the development of software-based NIV settings to enhance patient-ventilator synchrony.ConclusionsThe selection made by the experts suggests that some applications of NIV in critical care are supported by solid data (e.g. COPD exacerbation) while others are still waiting for confirmation. Moreover, the identified insights for the future would lead to improved clinical effectiveness, new comparisons and evaluation of its role in still “lack of full evidence” clinical settings.
Highlights
Noninvasive ventilation is used worldwide in many settings
Its effectiveness has been proven for common clinical conditions in critical care, such as cardiogenic pulmonary edema (CPE) and exacerbation of chronic obstructive pulmonary disease (COPD) [4,5,6,7], as well as for ventilatory support for patients with ventilatory pump failure and to prevent extubation failure [8,9,10]
The present survey among some of the worldwide leading experts aims to: 1) select and review 10 important articles published on Noninvasive ventilation (NIV) in critical care setting 2) highlight future directions for both research and clinical applications of this fundamental mode of ventilation that all critical care physicians should be skilled in applying
Summary
Its effectiveness has been proven for common clinical conditions in critical care such as cardiogenic pulmonary edema and chronic obstructive pulmonary disease exacerbations. Since the first pioneering studies of noninvasive ventilation in critical care in the late 1980s [1,2,3] thousands of studies and manuscripts have been published on this topic exploring different clinical applications, modalities, interfaces and comparisons with other therapies [4, 5]. Its effectiveness has been proven for common clinical conditions in critical care, such as cardiogenic pulmonary edema (CPE) and exacerbation of chronic obstructive pulmonary disease (COPD) [4,5,6,7], as well as for ventilatory support for patients with ventilatory pump failure and to prevent extubation failure [8,9,10]. The present survey among some of the worldwide leading experts aims to: 1) select and review 10 important articles published on NIV in critical care setting 2) highlight future directions for both research and clinical applications of this fundamental mode of ventilation that all critical care physicians should be skilled in applying
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